WALLACE J FORMHALS - Pharmacist License in Illinois | # 051014432

WALLACE J FORMHALS

Business Entity

INACTIVE

License Type

Pharmacist

Description

REGISTERED PHARMACIST

License Number

051014432

License Status

INACTIVE

Business

N

First Name

WALLACE J

Last Name

FORMHALS

Business Name

WALLACE J FORMHALS

Original Issue Date

01/01/1997

Expiration Date

03/31/1984

State

IL

Ever Disciplined

N

LastModifiedDate

10/17/2005